Date: Sunday, April 30, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 4:54pm-5:06pm
Background: The new kidney allocation system (KAS) led to an increase in DDTX among patients with ≥10 years of pre-TX dialysis exposure. We aimed to determine the survival benefit of DDTX in such patients.
Methods: Using USRDS we determined the survival benefit of DDTX in 2820 prevalent wait-listed patients aged <75 yrs who were on dialysis for >10 years through 1998-2000 (a contemporary cohort with 5 yrs of potential follow-up after 10 yrs on dialysis).
Survival was determined from the date of each patient's 10 year dialysis anniversary until the date of permanent removal from the waiting list, living donor TX, death or end of follow up using multivariate non-proportional hazards analysis with DDTX treated as a time dependent covariate.
Results: The Table shows the HR for death in the 1021 (36%) DDTX recipients with a mean of 12.5 ± 1.9 yrs of dialysis exposure compared to the 1799 patients who remained on dialysis. The median (Q1,Q3) KDPI of the transplanted kidneys was 45% (26%, 64%).
|% of cohort||HR (95% CI)|
|Deceased donor transplantation||36||0.49 (0.41, 0.59)|
|Age (years) after 10 years of dialysis initiation|
|≥ 60||27||3.93 (3,10,4.98)|
|Female||48||1.06 (0.95, 1.20)|
|Black||59||0.84 (0.74, 0.95)|
|Other||8||0.96 (0.77, 1.19)|
|Diabetes||26||1.70 (1.43, 2.03)|
|Other||51||1.15 (0.98, 1.35)|
|History of CVD (ref none)||12||1.03 (0.87, 1.22)|
|History of PVD (ref none)||2||1.22 (0.89, 1.68)|
|History of CVA (ref none)||2||1.13 (0.78, 1.63)|
Discussion: In a contemporary cohort of patients with 10 years of pre-TX dialysis exposure, DDTX was associated with a survival benefit compared to continued dialysis. Of note, the KDPI of kidneys transplanted was relatively low but similar to that of recipients with ≥ 10 years of pre-TX dialysis exposure in the post KAS era (median KDPI :51 (35,68)). Whether recipients of higher KDPI kidneys would derive a similar benefit remains uncertain. We conclude that DDTX in patients with ≥ 10 years of pre-TX exposure is justifiable on the basis of a survival benefit.
CITATION INFORMATION: Rose C, Gill J, Lesage J, Joffres Y, Gill J. Is Deceased Donor Kidney Transplantation (DDTX) Justified in Patients with More Than 10 Years of Pre-TX Dialysis Exposure? Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Rose C, Gill J, Lesage J, Joffres Y, Gill J. Is Deceased Donor Kidney Transplantation (DDTX) Justified in Patients with More Than 10 Years of Pre-TX Dialysis Exposure? [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/is-deceased-donor-kidney-transplantation-ddtx-justified-in-patients-with-more-than-10-years-of-pre-tx-dialysis-exposure/. Accessed November 23, 2020.
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